T Ryotokuji, MD, Y Izumi, MD PhD, T Kawano, MD PhD. Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo Medical and Dental University
BACKGROUND: Patients following esophagectomy often requires left chest tube drainage on the 3 or 4 postoperative day due to pleural effusions in the contralateral thoracic cavity of the right transthoracic procedure. Transthoracic intercostal drain placement is standard practice. However these chest tubes cause pain and hamper mobility, sometimes causing morbidity and delaying recovery. In patients following minimally invasive esophagectomy(MIE), these drains sometimes ruined the advantage of MIE. We introduced a novel transhiatal drainage for postoperative left pleural effusions.
AIM: The aim of this study is to investigate whether transhiatal chest tube drainage is effective and safe following minimally invasive esophagectomy.
METHODS:We placed 28Fr intercostal tube for right thoracic cavity and transhiatal silastic drain for left thoracic cavity intraoperatively. From Septemper 2005 we introduced transhiatal chest drainage using silastic drains. At the same time we stopped left subphrenic abdominal drainage. Transhiatal chest tube drainage in the left pleural cavity is performed in 54 patients undergoing minimally invasive esophagectomy including both thoracoscopic and laparoscopic approach.
RESULTS: No patient developed clinically significant pleural effusions in the left thoracic cavity, requiring further drainage. No complicatins were noted, associated with transabdominal chest tube and no drain for abdominal cavity.
CONCLUSION: Transhiatal chest tube drainage of the left pleural cavity is an effective and safe means of draining the chest, following minimally invasive esophagectomy. This technique can also be applied to transthoracic esophagectomy.
Program Number: P306